Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 17.064
Filtrar
1.
Infectio ; 25(4): 207-211, oct.-dic. 2021. tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1286715

RESUMO

Resumen Objetivo: Describir la proporción, características clínicas, demográficas y programáticas de casos fatales de coinfección TB/VIH de Cali-Colombia, en 2017. Material y Método: Estudio de corte transversal, con información de las bases de datos del programa de tuberculosis, las historias clínicas y unidades de análisis de mortalidad disponibles. Resultados: Se depuraron 257 casos fatales por TB, el 24,5% (63/257) falleció con coinfección TB/VIH. La mediana de edad fue 43 años (Rango Intercuartílico: 30-52), 73% (46/63) eran hombres, 76,2% (48/63) no pertenecían al régimen contributivo, 28,6% eran habitantes de calle. 81,2% (39/48) eran casos nuevos de TB, 76,6% (37/47), inició tratamiento; al 74,6% (47/63) se les realizó unidad de análisis de mortalidad. La presentación pulmonar fue frecuente (75,9%-44/58), en 60% de los registros se observó desnutrición (Índice de Masa Corporal <20), en 39,7% (25/63) dependencia al alcohol, tabaco o farmacodependencia. Conclusiones: La mortalidad asociada a TB/VIH es prevenible, pero en 2017 representó la cuarta parte de la mortalidad por TB en Cali. Hombres adultos con condiciones de vulnerabilidad social, diagnosticados en estados avanzados de enfermedad, fueron blanco de fatalidad. Mejorar los sistemas de información e integrar los programas de TB/VIH, deben ser estrategias prioritarias para la salud pública en Colombia.


Abstract Objective: To describe the proportion, clinical, demographic and programmatic characteristics of fatal cases of TB/HIV coinfection from Cali-Colombia, in 2017. Material and Method: Cross-sectional study, with information from the TB program databases, clinical records and mortality analysis units available. Results: 257 TB fatal cases were cleared in Cali in 2017, 24.5% (63/257) of these died with TB/HIV coinfection. The median age was 43 years (Interquartile Range: 30-52), 73% (46/63) were men, 76.2% (48/63) did not belong to the contributory health regimen, 28.6% were homeless. 81.2% (39/48) were new TB cases, 76.6% (37/47) started treatment; 74.6% (47/63) had mortality analysis register. Pulmonary presentation was frequent (75.9% -44 / 58), in 60% of the registries malnutrition was observed (Body Mass Index <20), in 39.7% (25/63), dependence on alcohol, tobacco or drug dependence was registered. Conclusions: Mortality associated with TB/HIV is preventable, but in 2017 it represented a quarter of the TB mortality in Cali. Adult men with conditions of social vulnerability, diagnosed in advanced stages of disease, were fatally targeted. Improving information systems and integrating TB/HIV programs should be priority strategies for public health in Colombia.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Tuberculose , HIV , Índice de Massa Corporal , Infecções por HIV , Saúde Pública , Estudos Transversais , Mortalidade , Estratégias de Saúde , Colômbia , Vulnerabilidade Social , Desnutrição
2.
J Glob Health ; 11: 13006, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34484713

RESUMO

Background: Adolescence is a highly vulnerable period of human life characterized by substantial physiological and cognitive changes for which adequate nutrition is crucial. To date, evidence on determinants, prevalence, and trends of undernutrition and anemia for the entire West and Central African region is missing. This paper provides evidence on trends and levels of adolescent anemia and undernutrition in West and Central Africa. Methods: We pooled all Demographic and Health Surveys (DHS) for West and Central African countries that were conducted between 1986 and 2017 to analyze levels and trends of adolescent anemia and undernutrition. We investigated the association of adolescent undernutrition and anemia within this region with World Bank income level classification of the country. Results: Our findings suggest that the regional prevalence of adolescent anemia and undernutrition remained high at 45% and 19% respectively over the last 20 years. Anemia increased in about one third of countries and undernutrition in about two thirds over the studied period. On the aggregated level, these trends are largely masked and both levels remained stable in the entire region between the years 1998 and 2017. The results of the multivariable regression analysis indicate an association of adolescence with undernutrition and anemia, which was independent of socio-economic factors such as income, education, and place of residence. Conclusion: We conclude that levels of adolescent undernutrition and anemia remain high with little progress over the last 20 years and that adolescence is a significant correlate of both anemia and undernutrition. Given the recognition of the international community that adolescent nutrition is an important public health concern in resource-poor settings, there is an urgent need to improve data availability, quality, and use for decision-making and to design successful high-impact interventions to combat adolescent malnutrition in low- and middle-income countries.


Assuntos
Anemia , Desnutrição , Adolescente , África Central , Anemia/epidemiologia , Feminino , Humanos , Renda , Desnutrição/epidemiologia , Estado Nutricional , Prevalência
3.
J Glob Health ; 11: 13007, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34484714

RESUMO

Background: Adolescence is a formative period when an individual acquires physical, cognitive, emotional, and social resources that are the foundation for later life, health, and well-being [1]. However, in West and Central African region, this trajectory is curtailed by early childbearing associated with an increased risk of undernutrition and anemia. Evidence on socio-economic determinants of anemia and undernutrition in adolescent mothers is limited. This paper aims to shed some light on this issue and, more specifically, assess the socio-economic determinants of anemia among childbearing adolescents in the region. Methods: For this observational study, we pooled data from all Demographic and Health Surveys (DHS) conducted in countries in West and Central Africa region between 1986 and 2017. Outcomes were undernutrition and anemia in adolescent mothers. Predictors were education, wealth, place of residence (rural/urban), and religion. Descriptive statistics were calculated using survey weights for individual surveys and in the pooled sample each country was additionally weighted with its population share. We estimated multiple regression models with and without primary sampling unit fixed effects for both outcomes. All regressions were linear probability models. Results: Having no formal education was the strongest predictor for both anemia and undernutrition. Belonging to the richest asset quintile was also associated with lower anemia and undernutrition prevalence in some specifications. While urban location of the mother was positively associated with anemia, there was no association with undernutrition. Conclusions: Overall, having any formal education emerged as a sole strong predictor of reduced adolescent maternal undernutrition and anemia. Promotion of female education can potentially serve as a high-impact intervention to improve adolescent girls' health in the region. However, we cannot make conclusions about its causal impact based on this study alone.


Assuntos
Anemia , Desnutrição , Adolescente , África Central , Anemia/epidemiologia , Escolaridade , Feminino , Humanos , Desnutrição/epidemiologia , Mães , Prevalência , Fatores Socioeconômicos
4.
World J Gastroenterol ; 27(30): 4985-4998, 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34497430

RESUMO

Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia. The presence of malnutrition causes a severe impact on patients with liver cirrhosis. The etiology of cirrhosis differs in the South Asian region compared to the West, with hepatitis B and C still being the leading causes and the prevalence of nonalcoholic fatty liver disease increasing over time. Comorbid malnutrition worsens outcomes for cirrhosis patients. Urgent attention to address malnutrition is needed to improve patient outcomes. The etiology and pathophysiology of malnutrition in liver diseases is multifactorial, as reduction in liver function affects both macronutrients and micronutrients. A need for nutritional status assessment for liver disease patients exists in all parts of the world. There are many widely studied tools in use to perform a thorough nutritional assessment, of which some tools are low cost and do not require extensive training. These tools can be studied and evaluated for use in the resource limited setting of a country like Pakistan. Treatment guidelines for proper nutrition maintenance in chronic liver disease exist for all parts of the world, but the knowledge and practice of nutritional counseling in Pakistan is poor, both amongst patients and physicians. Emphasis on assessment for nutritional status at the initial visit with recording of vital signs is needed. Simultaneously, treating physicians need to be made aware of the misconceptions surrounding nutritional restrictions in cirrhosis so that patient education is done correctly based on proper scientific evidence.


Assuntos
Hepatopatias , Desnutrição , Países em Desenvolvimento , Humanos , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Hepatopatias/terapia , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Desnutrição/terapia , Avaliação Nutricional , Paquistão/epidemiologia
5.
Medicine (Baltimore) ; 100(36): e27159, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516508

RESUMO

ABSTRACT: Severity of illness, age, malnutrition, and infection are the important factors determining intensive care unit (ICU) survival.The aim of the study is to determine the relations between Geriatric Nutritional Risk Index (GNRI), C-reactive protein/albumin (CAR), and prognosis-mortality of geriatric patients (age of ≥65 years) admitted to intensive care unit.The study with 10/15/2020, 697 approval date, and number retrospectively registered. Between January 1, 2018 and December 31, 2019, 413 geriatric patients admitted to ICU. The patients were divided into three groups according to their age.The age group, gender, Charlson comorbidity index, intensive care scores (Acute Physiology And Chronic Health Evaluation II and Sequential Organ Failure Assessment), the infection markers (white blood cell, procalcitonin, CAR levels), malnutrition tools for each patient (body mass index, Nutrition Risk in Critically ill score, and GNRI scores) were analyzed retrospectively. Also length of stay (LOS) ICU, length of stay hospital, and 30-day mortality were recorded.Geriatric patients number of 403 was included in the study. Forty-nine (12.3%) patients had a history of malignancy, 272 (67.5%) patients had Chronic Obstructive Pulmonary Disease comorbidity. There was no difference in mortality between age groups.In patients with mortality, body mass index, had being Chronic Obstructive Pulmonary Disease history, GNRI, length of stay hospital, and albumin were significantly lower; malignancy comorbidity rate, inotrope use, modified Nutrition Risk in Critically ill score, mechanical ventilation duration, LOS ICU, Sequential Organ Failure Assessment, Acute Physiology And Chronic Health Evaluation II, Charlson comorbidity index, C-reactive protein, procalcitonin, and CAR were significantly higher.Both malnutrition and infection affect mortality in geriatric patients in intensive care. The GNRI is better than CAR at predicting mortality.


Assuntos
Infecção Hospitalar/epidemiologia , Idoso Fragilizado , Desnutrição/epidemiologia , Síndrome do Desconforto Respiratório , APACHE , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/etiologia , Infecção Hospitalar/mortalidade , Feminino , Avaliação Geriátrica , Serviços de Saúde para Idosos , Humanos , Unidades de Terapia Intensiva , Masculino , Desnutrição/etiologia , Desnutrição/mortalidade , Avaliação Nutricional , Estado Nutricional , Turquia/epidemiologia
6.
JNMA J Nepal Med Assoc ; 59(234): 146-151, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506457

RESUMO

INTRODUCTION: Elderly population is more likely to suffer from malnutrition due to aging-associated factors that influence nutritional status like loss of appetite, swallowing difficulties, digestive problems, and chronic illness. There is insufficient information related to the nutritional status of the elderly in Nepal. Hence, this study aims to determine the prevalence of malnutrition among elderly people living in the rural area of the Kavrepalanchok district. METHODS: A descriptive cross-sectional study was conducted among 320 elderly people aged ≥60 years in a rural area of Kavre district from August to October 2019. Ethical approval was taken from the Institutional Review Committee (IRC-KUSMS: 68/19). Convenient sampling was done. Data analysis was performed using the Statistical Program for Social Sciences version 23. RESULTS: The prevalence of malnutrition and risk of malnutrition was 37 (11.6%) and 159 (49.7%), respectively. Of 320 elderly persons, 193 (60.3%) males and 127 (39.7%) females, with a mean age of 68.23±7.38 years, participated in this study. The mean BMI was 22.54±3.25 kg/m2 (Mean±SD). The prevalence of malnutrition was higher among females 19 (15%) compared to males 18 (9.3%). CONCLUSIONS: The prevalence of malnutrition and risk of malnutrition is high in the study population. Interventions to improve the nutritional status of the elderly should focus primarily on older people, females, and those who have co-morbidities.


Assuntos
Desnutrição , Avaliação Nutricional , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Nepal/epidemiologia , Prevalência , População Rural
7.
J Intensive Care Med ; 36(10): 1141-1148, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34519558

RESUMO

BACKGROUND: A previous study suggested an association between low caloric intake(CI), negative nitrogen balance, and poor outcome after subarachnoid hemorrhage(SAH). Objective of this multinational, multicenter study was to investigate whether clinical outcomes vary by protein intake(PI) or CI in SAH patients adjusting for the nutritional risk as judged by the modified NUTrition Risk in the Critically Ill (mNUTRIC) score. METHODS: The International Nutrition Survey(INS) 2007-2014 was utilized to describe the characteristics, outcomes and nutrition use. A subgroup of patients from 2013 and 2014(when NUTRIC score was captured) examined the association between CI and PI and time to discharge alive(TTDA) from hospital using Cox regression models, adjusting for nutrition risk classified by the mNUTRIC score as low(0-4) or high(5-9). RESULTS: There were 489 SAH patients(57% female with a mean ± SD age 57.5 ± 13.9 years, BMI of 25.9 ± 5.3 kg/m2 and APACHE-2 score 19.4 ± 7.0. Majority(85%) received enteral nutrition(EN) only, with a time to initiation of EN of 35.4 ± 35.2 hours. 64% had EN interrupted. Patients received a CI of 14.6 ± 7.1 calories/kg/day and PI 0.7 ± 0.3 grams/kg/day corresponding to 59% and 55% of total prescribed CI and PI respectively. In the 2013 and 2014 subgroup there were 226 SAH patients with a mNUTRIC score of 3.4 ± 1.8. Increased CI and PI were associated with faster TTDA among high mNUTRIC patients(HR per 20% of prescription received = 1.34[95% CI,1.03 -1.76] for CI and 1.44[1.07 -1.93] for PI), but not low mNUTRIC patients(CI: HR = 0.95[0.77 -1.16] PI:0.95[0.78 -1.16]). CONCLUSIONS: Results from this multicenter study found that SAH patients received under 60% of their prescribed CI and PI. Further, achieving greater CI and PI in hi risk SAH patients was associated with improved TTDA. mNUTRIC serves to identify SAH patients that benefit most from artificial nutrition and efforts to optimize protein and caloric delivery in this subpopulation should be maximized.


Assuntos
Desnutrição , Hemorragia Subaracnóidea , Adulto , Idoso , Estado Terminal , Ingestão de Energia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Inquéritos Nutricionais , Estado Nutricional , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/terapia
8.
Trials ; 22(1): 616, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521465

RESUMO

BACKGROUND: Internationally, older patients (≥65 years) account for more than 40% of acute admissions. Older patients admitted to the emergency department (ED) are frequently malnourished and exposed to inappropriate medication prescribing, due in part to the inaccuracy of creatinine-based equations for estimated glomerular filtration rate (eGFR). The overall aims of this trial are to investigate: (1) the efficacy of a medication review (MED intervention) independent of nutritional status, (2) the accuracy of eGFR equations based on various biomarkers compared to measured GFR (mGFR) based on 99mTechnetium-diethylenetriaminepentaacetic acid plasma clearance, and (3) the efficacy of an individualized multimodal and transitional nutritional intervention (MULTI-NUT-MED intervention) in older patients with or at risk of malnutrition in the ED. METHODS: The trial is a single-center block randomized, controlled, observer-blinded, superiority and explorative trial with two parallel groups. The population consists of 200 older patients admitted to the ED: 70 patients without malnutrition or risk of malnutrition and 130 patients with or at risk of malnutrition defined as a Mini Nutritional Assessment-Short Form score ≤11. All patients without the risk of malnutrition receive the MED intervention, which consists of a medication review by a pharmacist and geriatrician in the ED. Patients with or at risk of malnutrition receive the MULTI-NUT-MED intervention, which consists of the MED intervention in addition to, dietary counseling and individualized interventions based on the results of screening tests for dysphagia, problems with activities of daily living, low muscle strength in the lower extremities, depression, and problems with oral health. Baseline data are collected upon study inclusion, and follow-up data are collected at 8 and 16 weeks after discharge. The primary outcomes are (1) change in medication appropriateness index (MAI) score from baseline to 8 weeks after discharge, (2) accuracy of different eGFR equations compared to mGFR, and (3) change in health-related quality of life (measured with EuroQol-5D-5L) from baseline to 16 weeks after discharge. DISCUSSION: The trial will provide new information on strategies to optimize the treatment of malnutrition and inappropriate medication prescribing among older patients admitted to the ED. TRAIL REGISTRATION: ClinicalTrials.gov NTC03741283 . Retrospectively registered on 14 November 2018.


Assuntos
Desnutrição , Estado Nutricional , Atividades Cotidianas , Idoso , Hospitalização , Humanos , Desnutrição/diagnóstico , Desnutrição/tratamento farmacológico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Nutrients ; 13(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34444983

RESUMO

Appropriate nutrition is a cornerstone of preventive gerontology [...].


Assuntos
Envelhecimento , Dieta , Expectativa de Vida , Terapia Nutricional , Estado Nutricional , Idoso , Humanos , Desnutrição , Avaliação Nutricional
10.
Nutrients ; 13(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34445007

RESUMO

BACKGROUND: Although malnutrition and bone fracture are both major complications in patients undergoing hemodialysis, their association has not been clarified. The aim of our study was to clarify the association between the geriatric nutritional risk index (GNRI), an indicator of nutritional status, and the incidence of bone fractures in patients undergoing hemodialysis. METHODS: We included 1342 registered patients undergoing hemodialysis and performed a post hoc analysis. We divided patients into the high GNRI group (≥92), considered to have a low risk of malnutrition, and the low GNRI group (<92), considered to have a high risk of malnutrition. Fracture-free survival in the low and high GNRI groups was evaluated by the Kaplan-Meier method. Cox proportional hazards models were used to identify the risk factors for fractures requiring hospitalization. All results were stratified by sex. RESULTS: New bone fractures developed in 108 (8.0%) patients in 5 years of follow-up. Bone fractures occurred more frequently in the low GNRI group compared with the high GNRI group (HR: 3.51, 95% CI: 1.91-6.42, p < 0.01 in males; HR: 2.47, 95% CI: 1.52-4.03, p < 0.01 in females). A low GNRI was significantly associated with an increased incidence of bone fractures, even after adjustment for covariates. However, the serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase were not associated with the incidence of bone fractures. CONCLUSIONS: A low GNRI is an independent risk factor for bone fractures in patients undergoing hemodialysis. Early intervention for the low GNRI group may be important in preventing the occurrence of fractures.


Assuntos
Fraturas Ósseas/epidemiologia , Avaliação Geriátrica , Nefropatias/terapia , Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Diálise Renal/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Fraturas Ósseas/diagnóstico , Humanos , Incidência , Japão/epidemiologia , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
11.
Nutrients ; 13(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34445010

RESUMO

BACKGROUND: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. METHODS: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system. RESULTS: Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities. CONCLUSION: MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.


Assuntos
Cuidados Críticos , Alimentos Formulados , Desnutrição/terapia , Estado Nutricional , Apoio Nutricional , Ingestão de Energia , Nutrição Enteral , Alimentos Formulados/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Apoio Nutricional/efeitos adversos , Valor Nutritivo , Nutrição Parenteral , Resultado do Tratamento
12.
J Immunol Res ; 2021: 9917302, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34337084

RESUMO

Background: The prognostic nutritional index (PNI) has been reported to significantly correlate with poor survival and postoperative complications in patients with various diseases, but its relationship with mortality in COVID-19 patients has not been addressed. Method: A multicenter retrospective study involving patients with severe COVID-19 was conducted to investigate whether malnutrition and other clinical characteristics could be used to stratify the patients based on risk. Results: A total of 395 patients were included in our study, with 236 patients in the training cohort, 59 patients in the internal validation cohort, and 100 patients in the external validation cohort. During hospitalization, 63/236 (26.69%) and 14/59 (23.73%) patients died in the training and validation cohorts, respectively. PNI had the strongest relationships with the neutrophil-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) level but was less strongly correlated with the CURB65, APACHE II, and SOFA scores. The baseline PNI score, platelet (PLT) count, LDH level, and PaO2/FiO2 (P/F) ratio were independent predictors of mortality in COVID-19 patients. A nomogram incorporating these four predictors showed good calibration and discrimination in the derivation and validation cohorts. A PNI score less than 33.405 was associated with a higher risk of mortality in severe COVID-19 patients in the Cox regression analysis. Conclusion: These findings have implications for predicting the risk of mortality in COVID-19 patients at the time of admission and provide the first direct evidence that a lower PNI is related to a worse prognosis in severe COVID-19 patients.


Assuntos
Plaquetas/patologia , COVID-19/diagnóstico , Desnutrição/epidemiologia , Avaliação Nutricional , SARS-CoV-2/fisiologia , Idoso , COVID-19/epidemiologia , COVID-19/mortalidade , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Hidroliases/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Quinina , Estudos Retrospectivos , Análise de Sobrevida
13.
BMJ Open ; 11(8): e047276, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353796

RESUMO

OBJECTIVES: To investigate the role of the intersection of maternal empowerment, paternal gender-equitable attitudes, and household wealth in stunting and severe stunting among underfives in India. DESIGN: Cross-sectional study. SETTING: Community-based setting, nationally representative household survey from India. PARTICIPANTS: We used a sample of 22 867 mother-father-child triads from the fourth round of India's National Family Health Survey (2015-2016). Our inclusion criterion was children below the age of 5 years. The exclusion criterion was a lack of information on paternal gender-equitable attitudes and maternal empowerment. Observations with missing data on any of the covariates were also excluded. PRIMARY OUTCOME: Stunting and severe stunting among underfives in India. RESULTS: Our survey-adjusted logistic regression models revealed that even among children from poorer households, those with either an empowered mother or a father with gender-equitable attitudes versus those with none such parents, had a lower odds of stunting (adjusted OR (AOR): 0.92, 95% CI: 0.84 to 1.02) and severe stunting (AOR: 0.87, 95% CI: 0.77 to 0.98), independent of all covariates. We also found substantially lower odds of severe stunting in groups with parental concordance in a woman-friendly outlook, whether non-affluent (AOR: 0.80, 95% CI: 0.67 to 0.94) or affluent (AOR: 0.50, 95% CI: 0.38 to 0.67). CONCLUSION: We argue that while women's autonomy could reduce the risk of child undernutrition, focusing on men's attitudes towards gender equity also holds promise for reducing undernutrition. Our findings not only underscore how patriarchy is embodied in undernourished children, but also suggest programmatic interventions to address this deep-rooted scourge in India.


Assuntos
Pai , Desnutrição , Atitude , Pré-Escolar , Estudos Transversais , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Índia/epidemiologia , Lactente , Masculino , Desnutrição/epidemiologia , Prevalência , Fatores de Risco
14.
Nutrients ; 13(7)2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34371849

RESUMO

The double burden of malnutrition (DBM) affects many low- and middle-income countries. However, few studies have examined DBM at the individual level, or undernutrition and overnutrition co-occurring within the same person. This study aims to investigate the prevalence and determinants of DBM among adults in the Philippines. Data from the 2013 National Nutrition Survey were used. The sample size in the analysis was 17,010 adults aged ≥20 years old, after excluding pregnant and lactating women. DBM was defined as the co-occurrence of overweight/obesity and anemia (definition #1), overweight/obesity and anemia or vitamin A deficiency (definition #2), and overweight/obesity and anemia or vitamin A deficiency or iodine insufficiency (definition #3). Anthropometric measurements and biochemical markers were used for DBM assessment. Data were analyzed using descriptive statistics, the chi-square test, and logistic regression by R software. Results showed that definition #3 is the predominant type of DBM (7.0%) in the general population, whereas the prevalence of DBM has increased to 23.7% in overweight/obese persons. Sex, age, educational attainment, marital status, household size, wealth quintile, and smoking status were the determinants of DBM. This study revealed that Filipino adults experience malnutrition critically and must be addressed through food and nutrition interventions.


Assuntos
Desnutrição/epidemiologia , Micronutrientes/deficiência , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Determinantes Sociais da Saúde/etnologia , Adulto , Anemia/epidemiologia , Anemia/etnologia , Antropometria , Comorbidade , Feminino , Inquéritos Epidemiológicos , Humanos , Iodo/deficiência , Modelos Logísticos , Masculino , Desnutrição/etnologia , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estado Nutricional , Obesidade/etnologia , Hipernutrição/epidemiologia , Hipernutrição/etnologia , Sobrepeso/etnologia , Filipinas/epidemiologia , Filipinas/etnologia , Prevalência , Fatores Socioeconômicos , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina A/etnologia , Adulto Jovem
16.
Nutrients ; 13(7)2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34371823

RESUMO

Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.


Assuntos
Serviços de Saúde Comunitária/métodos , Fragilidade/epidemiologia , Serviços de Saúde para Idosos , Desnutrição/epidemiologia , Terapia Nutricional/métodos , Sarcopenia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/terapia , Humanos , Vida Independente , Masculino , Desnutrição/diagnóstico , Desnutrição/terapia , Prevalência , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/terapia
17.
Malawi Med J ; 33(1): 37-47, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34422232

RESUMO

Background: Disability is a major determinant of impaired health and nutritional status. This study aims to assess the health and nutritional status of adults with disability and their relationship with socio-demographic factors. Methods: A descriptive cross-sectional study of 323 adults with disability in support-centers/schools of disability in Enugu Metropolis, Nigeria was conducted. The participants' socio-demographic factors, behavioural characteristics and 24-hour dietary recall were recorded. Blood pressure and anthropometric measurements of height, weight, waist and hip circumference were obtained. The height and weight measurements of non-ambulatory participants were estimated from knee height and mid-arm circumference. Biochemical analyses of blood samples were also performed. Multiple logistic regression was used to assess the effect of socio-demographic factors on health and nutritional status. Results: The participants consisted of females (59.3%) within the age of 20 to 30 years (59.1%). The major area of difficulty was in physical mobility (51.1%) and this occurred mostly in females (26.9%). The participants' mean daily intakes of calorie, protein and fat were below the recommended dietary allowances. The participants were overweight (49.2%), obese (4.6%), hypertensive (29.7%) and diabetic (12.1%). Dyslipidemia (81.8%), anemia (63.6%) and zinc deficiency (51.1%) were highly prevalent among the study group. Gender difference was observed in alcohol consumption (p=0.000), smoking habit (p=0.001), waist circumference (WC)(p=0.000), waist-hip-ratio (WHR) (p=0.000), triglyceride (p=0.026) and haemoglobin concentration (p=0.007). Being boarder was a positive predictor of overweight/obesity (OR= 2.974, 95% CI=1.449-6.104), abnormal WHR (OR=2.893, 95% CI = 1.073-7.801) and hypertension (OR=8.381, 95% CI=1.598-13.959). Female gender was associated with abnormal WC (OR=7.219, 95% CI=3.116-14.228) and WHR (OR=3.590, 95% CI=2.095-6.150) whereas older age-group was associated with overweight/obesity (OR=1.908, 95% CI=1.137- 3.202). Being employed was a negative predictor of hypertension. Conclusion: Overweight/obesity, anemia, zinc deficiency and dyslipidemia were highly prevalent among persons living with disability in Enugu Metropolis.


Assuntos
Pessoas com Deficiência , Nível de Saúde , Desnutrição/epidemiologia , Adulto , Estatura , Índice de Massa Corporal , Peso Corporal , Estudos Transversais , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Nigéria/epidemiologia , Estado Nutricional , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fatores Socioeconômicos , Populações Vulneráveis , Circunferência da Cintura , Relação Cintura-Quadril , Adulto Jovem , Zinco/deficiência
18.
PLoS One ; 16(8): e0256330, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34449773

RESUMO

BACKGROUND: COVID-19 has proved to have an indirect impact on essential health services in several parts of the world which could lead to increased morbidity and mortality and loss of the gains made in the past decades. There were no synthesized scientific evidences which could show the impact of COVID-19 epidemics/pandemic on essential health services in Tigray, Northern Ethiopia. Therefore, this study aimed to assess the impacts of COVID-19 epidemics/pandemic on essential health services provision in Tigray, Northern Ethiopia. METHODS: A pre-post study design was used to assess the impacts of COVID-19 on essential health services delivery in Tigray, Northern Ethiopia in the second quarter of 2020 (Post COVID-19) compared to similar quarter in 2019 (Pre COVID-19). The study focuses on five categories; namely; maternal, neonatal and child health care; communicable diseases with a focus on HIV and TB-HIV co-infection; prevention of mother to child transmission of HIV; basic emergency, outpatient, inpatient and blood bank services, non-communicable diseases and road traffic accidents (RTAs). Analysis was done using Stata version 14.0 software package. The effects of COVID-19 epidemics/pandemic were calculated taking the differences between post COVID -19 and pre COVID-19 periods and the levels of service disruptions presented using proportions. Wilcoxon sign rank test was done and a significance level of ≤0.05 was considered as having significant difference among the two quarters. RESULTS: There were significant increase in institutional delivery, delivery by Caesarian Section (CS), still birth, postnatal care within 7 days of delivery, the number of children who received all vaccine doses before 1st birthday, the number of under 5 children screened and had moderate acute malnutrition, the number of under 5 children screened and had severe acute malnutrition and children with SAM admitted for management. However, there were significant decrease in HIV testing and detection along with enrolment to antiretroviral therapy (ART) care, number of patients with cardiovascular disease (CVD) risk ≥ 30% received treatment, RTAs, total units of blood received from national blood transfusion service (NBTS) and regional blood banks, total number of units of blood transfused and emergency referral. There were no significant changes in outpatient visits and admissions. CONCLUSION: Despite commendable achievements in maintaining several of the essential health services, COVID-19 has led to an increase in under nutrition in under five children, decline in HIV detection and care, CVD, cervical cancer screening and blood bank services. Therefore, governments, local and international agencies need to introduce innovative ways to rapidly expand and deliver services in the context of COVID-19. Moreover, lower income countries have to customize comprehensive and coordinated community-based health care approaches, including outreach and campaigns. In addition, countries should ensure that NCDs are incorporated in their national COVID-19 response plans to provide essential health care services to people living with NCDs and HIV or HIV-TB co-infection during the COVID-19 pandemic period.


Assuntos
COVID-19/epidemiologia , Atenção à Saúde , Antirretrovirais/uso terapêutico , Transfusão de Sangue/estatística & dados numéricos , COVID-19/virologia , Doenças Cardiovasculares/diagnóstico , Parto Obstétrico/estatística & dados numéricos , Etiópia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Pandemias , Cuidado Pós-Natal , SARS-CoV-2/isolamento & purificação , Vacinação/estatística & dados numéricos
19.
World J Gastroenterol ; 27(29): 4862-4878, 2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34447231

RESUMO

Sarcopenia is becoming a well-established player in evaluating patients with chronic liver disease. Data regarding its clinical significance and consequences in the course of liver disease have been growing; many of the data support the idea that it impacts decompensation event frequency, prolonged hospitalization, and mortality, as well as providing the possibility to better prioritize patients on lists awaiting liver transplantation. When assessing the whole clinical scope of the field, which includes malnutrition and frailty, as well as the complete spectrum of muscle mass, strength, and function, it becomes clear that a well-founded approach in everyday clinical practice is essential. In this respect, this article attempts to unveil the most recently published data regarding possible methods and modalities that could be used to diagnose sarcopenia as early as possible, along with the required accuracy and reliability. From the most important field discoveries to data that need further clarification, the merits and weaknesses of the very diverse existing evaluation methods are presented. Finally, a critical overview is given, in an attempt to discern study lines of importance from those that could pose further ambiguity for the theme. The author also poses relevant questions that remain unanswered but are of clinical importance in the field.


Assuntos
Transplante de Fígado , Desnutrição , Sarcopenia , Humanos , Cirrose Hepática/diagnóstico , Desnutrição/diagnóstico , Reprodutibilidade dos Testes , Sarcopenia/diagnóstico
20.
Ned Tijdschr Geneeskd ; 1652021 07 29.
Artigo em Holandês | MEDLINE | ID: mdl-34346584

RESUMO

Two cases are described of patients who present with severe malnutrition more than five years after undergoing a Roux-en-Y gastric bypass and who have deficiencies of both micronutrients (vitamins and minerals) and macronutrients (proteins). This problem appears to be caused by both iatrogenic malabsorption after gastric bypass as well as dysphagia due to a local anastomotic complication (stenosis and marginal ulcer). Although both the severity of the deficiencies and the timing are exceptional, we want to emphasize the importance of lifelong supplement use and follow-up after bariatric surgery. Given the important role of general practitioners in this, we argue for implementation of this topic in national guidelines to improve the quality of follow-up.


Assuntos
Derivação Gástrica , Desnutrição , Obesidade Mórbida , Seguimentos , Derivação Gástrica/efeitos adversos , Humanos , Desnutrição/etiologia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias , Vitaminas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...